皮肤Merkel细胞癌7例临床病理分析

发布时间：2018-06-19 23:51

本文选题：皮肤 + Merkel细胞癌　；参考：《诊断病理学杂志》2014年02期

【摘要】：目的分析皮肤Merkel细胞癌的临床病理特点、免疫组化表型及其生物学行为。方法对7例皮肤Merkel细胞癌进行临床及病理资料分析、免疫组化检测及术后随访。结果 7例Merkel细胞癌患者中,男性5例,女性2例;发病年龄59~78岁,平均年龄67岁;发生部位为头颈部及四肢皮肤,多为暴露部位。临床主要表现为孤立性、无痛性、半球形结节或硬结样斑块,直径均2 cm,其中有2例形成溃疡。组织学主要表现为由嗜碱性、大小一致、胞质很少的瘤细胞构成,核呈圆形或卵圆形;肿瘤细胞在真皮内多呈弥漫状或实性巢状分布,其中1例伴灶状坏死并有鳞状分化,局灶区域癌变。免疫组化:肿瘤细胞上皮标记CK20和EMA均(+),神经内分泌标记Syn、CD56和NSE均(+),LCA、TTF-1、S-100和CD99为(-)。随访5例,3例预后良好,未见转移及复发,1例伴有鳞状细胞癌患者术后复发,并进展为浸润性鳞状细胞癌;另1例术后数月发现远处淋巴结转移。结论 Merkel细胞癌是一种较少见的、发生于真皮的神经内分泌肿瘤,可复发与转移,定期随访十分重要。病理诊断需要与基底细胞癌、恶性黑色素瘤、淋巴瘤、低分化鳞状细胞癌、原发性外周PNET、皮肤基底细胞癌以及转移性神经内分泌癌等鉴别。
[Abstract]:Objective to analyze the clinicopathological characteristics, immunohistochemical phenotype and biological behavior of skin Merkel cell carcinoma. Methods the clinical and pathological data of 7 cases of skin Merkel cell carcinoma were analyzed. Results among the 7 cases of Merkel cell carcinoma, 5 cases were male and 2 cases were female. The onset age was 5978 years old with an average age of 67 years. The main clinical manifestations were solitary, painless, hemispherical nodules or sclerosed plaques, each with a diameter of 2 cm, among which 2 cases developed ulcers. Histologically, the tumor cells were mainly composed of basophilic, uniform size, few cytoplasm, round or oval nuclei, and the tumor cells distributed diffusely or solid nests in the dermis, one of which was accompanied by focal necrosis and squamous differentiation. Canceration of the focal area. Immunohistochemical staining showed that CK20 and EMA were labeled by epithelial cells and CD56 and NSE were detected by neuroendocrine markers (LCATTF-1 S-100 and CD99). The prognosis of 5 patients with squamous cell carcinoma was good, and no metastasis or recurrence was found in 1 patient with squamous cell carcinoma, and one patient with invasive squamous cell carcinoma and one patient with distant lymph node metastasis after operation. Conclusion Merkel cell carcinoma is a rare neuroendocrine tumor, which can be recurred and metastasized. It is very important to follow up regularly. Pathological diagnosis should be differentiated from basal cell carcinoma, malignant melanoma, lymphoma, poorly differentiated squamous cell carcinoma, primary peripheral PNET, cutaneous basal cell carcinoma and metastatic neuroendocrine carcinoma.
【作者单位】：成都军区总医院病理科;
【分类号】：R739.5

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